Treating Cancer in Different Layers of the Bladder
- The bladder wall has four layers, and how far cancer grows into those layers helps determine treatment. Tumors confined to the inner lining may be treated locally in the bladder, while deeper tumors often require chemotherapy, surgery, radiation, or combination therapy.
- The muscle layer is the turning point where doctors become much more concerned that the cancer could move beyond the bladder.
- “Once the cancer gets in there, it essentially has access to small blood vessels that allow tumor cells that are shed by the cancer to jump into the bloodstream,” Dr. Sarah Psutka, a urologic oncologist at the University of Washington and Fred Hutchinson Cancer Center, tells SurvivorNet.
- This is why treatment for muscle-invasive bladder cancer is often more aggressive and involves more than one step. Treatments may be given before or after surgery, or both, to reduce the risk that any cancer cells are left lingering.
“There’s the inner layer, it’s like the inside of your mouth, it’s a mucosal layer. There’s a soft tissue layer below that, then there’s a muscle layer. And then there’s this fatty layer outside of the bladder,” Dr. Sarah Psutka, a urologic oncologist at the University of Washington and Fred Hutchinson Cancer Center, tells SurvivorNet.
Read MoreWhen Cancer Crosses Into The Muscle Wall
The bladder’s layers act almost like barriers. In the earliest stages, bladder cancer may stay in the inner lining. At that point, it is often more contained. But when it grows deeper, especially into the muscle layer, it becomes much more concerning. “The muscle layer is this really important boundary,” Dr. Psutka notes. Once cancer crosses into the muscle, doctors start worrying much more about the possibility that some cancer cells may have already escaped the bladder.When a bladder tumor reaches the muscle, it is closer to blood vessels and lymphatic channels that can carry cancer cells elsewhere in the body.
“Once the cancer gets in there, it essentially has access to small blood vessels that allow tumor cells that are shed by the cancer to jump into the bloodstream,” Dr. Psutka explains. “You can also have something called lymphovascular invasion, which is where some of those small tiny cells can jump into our lymphatic fluid system or channels.”
That is why treatment for muscle-invasive bladder cancer is often more aggressive and usually involves more than one step. Treatments may be given before or after surgery, or both, to reduce the risk that any cancer cells are left lingering in the body.
Neoadjuvant: Treatment Before Surgery
When bladder cancer has grown into the muscle layer, doctors often recommend chemotherapy before surgery, a strategy known as neoadjuvant therapy. The goal is to treat possible cancer cells throughout the body, even if scans do not show that the disease has spread.
“That’s actually the whole rationale behind giving medicine for the whole body before we go ahead and just do the surgery,” Dr. Psutka explains.
Even when imaging looks normal, doctors worry about microscopic disease, or tiny cancer cells that may have already escaped the bladder but are too small to detect.
“We worry that at any time, if the cancer has gotten into the muscle layer, there’s microscopic disease that we can’t see on any kind of radiographic testing outside of the bladder,” Dr. Psutka adds.
By treating the whole body first, doctors hope to eliminate those hidden cells early, improving the chances that surgery can remove the remaining cancer successfully.
Adjuvant: Treatment After Surgery
For some patients, treatment does not end with surgery. After the bladder is removed, doctors may recommend additional therapy aimed at lowering the risk that the cancer returns. This is often called adjuvant or consolidation therapy.
“I come in after we’ve treated as much of the cancer as we can with medicine, and then we take out what’s left,” Dr. Psutka explains. “I tell patients I’m the cleanup crew.”
Depending on the patient and the features of the tumor, additional therapy after surgery may include chemotherapy, immunotherapy, or participation in a clinical trial to further reduce the risk of recurrence.
Questions To Ask Your Doctor
- What layer of the bladder is my cancer in?
- Is there a chance that cancer has spread outside the bladder?
- Will I need treatment before or after surgery?
- What steps can we take to reduce the risk of recurrence?
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